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NPI Code Detail

MEDICARE: DR. CIELO MARIE MACA MD

MEDICARE: DR. CIELO MARIE MACA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RP1001XPulmonary Disease Physician2006007765MO
2207RP1001XPulmonary Disease Physician015849ME
3207RC0200XCritical Care Medicine (Internal Medicine) Physician37314AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053359158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CIELO MARIE MACA MD
Provider Business Mailing Address
First Line : 6250 CREEKSEDGE DR
Second Line :
City : OZARK
State : MO
Zip : 65721-6613
Country : US
Telephone Number : 417-631-8605
Fax Number :
Provider Business Practice Location Address
First Line : 600 N MAIN ST
Second Line :
City : MOUNT VERNON
State : MO
Zip : 65712-1004
Country : US
Telephone Number : 417-461-5215
Fax Number : 417-461-5729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 11/03/2013

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1003837162 — MRS. JILL LYNETTE GRIESBAUM MS, RD
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Directions to “ DR. CIELO MARIE MACA MD” Practice Location

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